A year-long investigation into operations at the Rahima Moosa Mother and Child Hospital (RMMC) has confirmed mothers slept on floors, the CEO was largely absent from duty and patient dignity was compromised. Releasing a report on the conditions at RMMC on Tuesday, Health Ombudsman Malegapuru Makgoba says interviewees most often described the facility, once considered iconic, as ‘dirty, filthy and unsafe’.

“The most striking thing about the investigation report is the overall finding that GDoH is in a mess and has been for at least seven years. The patterns I have seen in my experience investigating the Life Esidimeni tragedy in 2016, the Tembisa Hospital COVID-19 death in 2021, and the current complaint of the Rahima Moosa hospital, are all similar. The monitoring and evaluation systems are weak,” says Makgoba.

Health Minister Joe Phaahla describes the report as ‘sobering, and one that clearly confirms the shortcomings in the health system.’ 

“While this is about a specific hospital, we are aware that a number of other facilities in the system suffer similar deficiencies and challenges. The lack of maintenance of the building and ablution facilities reflects the huge pressure on services”, he says. 

Incompetent CEO

The investigation found that Gauteng, unlike other provinces, lowered their criteria for appointing a CEO at the hospital in 2020. 

“When we looked at CEO choices, the selection committee and the employer didn’t seem to read what the referee report said. They ignored choosing somebody who is of quality and has experience to lead the hospital”, says Makgoba. 

The complaint that the hospital’s CEO, Dr Nozuko Mkabayi, was not working full time to ensure that operations at the hospital were running smoothly, was found to be true.  Mkabayi had a total shortfall of 98 days that could not be accounted for over the years 2021 and 2022, leaving the hospital staff with no leadership. 

“The issue of the CEO position being filled is a representation of the lapses in management that we have to deal with. If we don’t have a leader, then very little will go right”, says Health Minister, Joe Phaahla. 

Dysfunctional services, unsafe environment

Pregnant women sleeping on floors, broken toilets, overcrowding and a dirty environment were all found to be true. The lack of cleanliness is fertile ground for common infections, with newborns being the most vulnerable. In 2018, the facility admitted it was to blame for the death of nine babies due to a bacterial outbreak. 

The highly specialised facility provides high-risk specialist obstetrics, gynaecology, neonatology, paediatric and surgical services, but doesn’t have laboratory (NHLS) and blood bank services (SANBS) that operate 24 hours a day, making it inefficient. 

The building has not received any substantial upgrades since it was built in 1943, and is ridden with ageing infrastructure and failing sewage reticulation system, leading to pipe spillages and toilet blockages. 

There is only one CT scan machine that was purchased in 2006 which doesn’t function. There is no intensive care unit (ICU) for adults- patients who need the ICU are placed into an operating theatre, which is closed until a vacant bed is found.

Makgoba says that security of staff and patients was also a challenge, with multiple incidents of muggings and vehicle theft reported. 

“The security team doesn’t have equipment to perform their jobs as security guard”, he says. 

Additional problems include the chronic shortage of nursing staff and the flouting of supply chain management processes, which Makgoba says is another word for corruption.

 “What we found is that staff at the hospital would place orders for medical supplies and medicines. There’d be delays, incompletions, or improper assessment of applications and the CEO would send them back with no signature of approval. Staff would wait for the CEO to be on leave and go to someone else who doesn’t know procedures and get them to sign,” explains Makgoba.

Recommendations and the next step

Recommendations include the appointment of a suitable and permanent CEO who is ‘fit for purpose’, the transfer of Dr Mkabayi to GDoH Provincial Office, and the prioritisation of RMMCH for infrastructure refurbishment within six months. 

“We want to commit to the Health Ombud and his team – that we will work together with the province to expedite remedial action that is required to address the infrastructure refurbishment required, but also in terms of management capacity”, says Phaahla. 

The Gauteng Department of Health says it welcomes the findings, and will start taking action to address the issues. An implementation plan is to be submitted in the next six months.-Health-e News